Pseudoaccomodation In A Patient With Post-Lasik Ectasia Following Cataract Surgery: Case Report And Description Of A Rare Entity

to report a clinical and functional results of a case of pseudoaccomodation in a patient with post-Lasik ectatia following cataract surgery and implantation of a toric IOL

European Medical Center, Moscow, Russia

A 64-year-old female presented with bilateral visual impairment. Her ophthalmic history was significant for LASIK surgery in both eyes due to moderate myopia 20 years ago.  Clinical examination revealed moderate post-Lasik ectasia and 2+ nuclear sclerotic cataract in the right eye, and significant keratoconus in the left eye. In the right eye, IOLMaster K readings were 41.67 at 38º and 46.21 at 128º, i.e 4.54 D of cylinder. This matched up well with the K readings from the Galilei tomography in the right eye. Topography showed a relatively mild inferotemporal cone. She underwent phacoemulsification with toric IOL implantation in the right eye (Сlareon toric 16D, CNWT6).  1 month following surgery the UDVA was 6/6, with a refraction of -0.25-0.50x140 and UNVA Jaeger 3 text in a handlheld near chart.  Postoperative follow up one year after surgery showed no signs of post-Lasik ectasia progression and visual acuity remained the same.

This clinical case demonstrates that corneal multifocality (refractive power gradient within the pupillary area) in a patient with post-Lasik ectasia contributes to apparent multifocality.  Patients with mild keratoconus can benefit from monofocal/toric IOLs to reduce their astigmatism and provide improved postoperative UCVA for far and near vision.